Form Center

By signing in or creating an account, some fields will auto-populate with your information.

Supervisor's Investigation Report

Steps

  1. 1. 1
  2. 2. 2
  • 1

    1. City of Gadsden Supervisor's Report Form
    2. Section A - WORKER'S COMPENSATION
    3. Did employee ask to see a doctor?
    4. Was employee released to return to work?
    5. If so, attach copy of release; if not, attach copy of disability certification.
      NOTE: NO DISABILITY IS PAYABLE UNLESS AUTHORIZED BY DOCTOR.
    6. Section B - VEHICLE ACCIDENTS
    7. City Vehicle:
    8. Other Vehicle:
    9. Section C - POTENTIAL LIABILITY CLAIM
    10. Type Claim:
    11. Section D - DAMAGE TO CITY PROPERTY